1871689315 NPI number — COMMUNITY HEALTH ALLIANCE OF PASADENA

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1871689315 NPI number — COMMUNITY HEALTH ALLIANCE OF PASADENA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COMMUNITY HEALTH ALLIANCE OF PASADENA
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
CHAPCARE-FAIR OAKS
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1871689315
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/12/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
455 W MONTANA ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PASADENA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91103-1327
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
626-993-1212
Provider Business Mailing Address Fax Number:
626-993-1288

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1855 N FAIR OAKS AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PASADENA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91103-1620
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
626-398-6300
Provider Business Practice Location Address Fax Number:
626-398-5948
Provider Enumeration Date:
10/04/2006

Additional Information

Authorized Official

Authorized Official Last Name:
MARTINEZ
Authorized Official First Name:
MARGARET
Authorized Official Middle Name:
BANDA
Authorized Official Title or Position:
CHIEF EXECUTIVE OFFICER
Authorized Official Telephone Number:
626-993-1227

Provider Taxonomy Codes

  • Taxonomy code: 261QF0400X , with the licence number:  960001053 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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